HomeMy WebLinkAboutDBM co (39) JUDITH T.TERRY ; ® -� •
Town Hall,53095 Main Road
TOWN CLERK P.O.Box 1179
REGISTRAR OF VITAL STATISTICS •� 1% Southold,New York 11971
MARRIAGE OFFICER O QQN"/ Fax(516)765-1823
RECORDS MANAGEMENT OFFICER .4f � Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER
,•• �
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3315-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner DBM CO.
Mailing Address 1 P. O. BOX 2130
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 1000 ORIOLE DRIVE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-477-2223
Tax Map No. section 55.00 block 6 lot 15.036
Cross Street LISA DRIVE
Issue Date: 3/20/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK �,�FF� a
Town of Southold i �QS` " `� C'�G�� Application No.
Judith T. Terry, Town"Clerkf � $10.00 - Residential ---------
Town Hall, 53095Main Road
P 0. Box 117 9tr3 �`,
:�.r.., tA4 $25.00 - Non-Residential
Southold, New York 11971
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ • •
DATE 3-49.5
OWNER NAME: 6 M C-e) • •
OWNER MAILING ADDRESS: LI 4 3 HA / 5 %. N• v• £ax 2-t3r,
C� 2c=E ) a2 i 4v rr 9 4Y
OWNER PROPERTY ADDRESS: I b O o O R 1 -b,02 (
SO v -rI-t-c L b AY I 1 9 -
OWNER TELEPHONE NUMBER: ‘.5-I b - t 71- 3
TAX MAP NO. : Section S5 Block 06 Lot /6", 3 6
CROSS STREET: L I S hl J
TYPE OF SYSTEM: Septic Tank ✓ New / Existing
Cesspool _ New r - Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: ^.)//3
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
ill/ :ti r.-o ''� . olicant
RECEIVED BY: RIMED
Town Clerk's,Office
MAR 1 lvvo
DATE:
lava' Clerk Ent![0!d